---
title: UnitedHealthcare Community Plan of Indiana ABA coverage (Hoosier Care Connect + PathWays for Aging).
url: "https://carelu.com/payers/unitedhealthcare-community-plan-indiana"
markdown_url: "https://carelu.com/payers/unitedhealthcare-community-plan-indiana.md"
state: IN (Indiana)
payer: UnitedHealthcare Community Plan of Indiana
kind: Medicaid managed care plan (MCO)
parent_program: Indiana Medicaid (IHCP)
description: "How UnitedHealthcare Community Plan administers Indiana Medicaid ABA for Hoosier Care Connect — the Optum behavioral-health carve-out, separate ABA network credentialing, the ABA Treatment Request Form, and decision timelines."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

# UnitedHealthcare Community Plan of Indiana ABA coverage (Hoosier Care Connect + PathWays for Aging).

_Payer Guide · UHC Community Plan (IN) · Last updated October 2026 · 23 primary sources_

> Hoosier Care Connect + PathWays for Aging ABA via the Optum carve-out — not HIP/Hoosier Healthwise.

UnitedHealthcare Community Plan of Indiana is scoped to Hoosier Care Connect — Indiana's plan for aged, blind, and disabled members and children in foster care — and PathWays for Aging, for members 60+ and dual-eligible adults; per FSSA's own managed-care plan roster, UHC does NOT serve HIP or Hoosier Healthwise in Indiana, unlike Anthem, CareSource, and MHS. ABA runs through an Optum Behavioral Health carve-out. Clinical criteria default to Indiana Medicaid policy (state rules sit atop UHC's stated hierarchy, with InterQual as backstop); the operational reality is that ABA lives on Optum's rails: a separate provider network, Provider Express submission, and Optum's ABA Treatment Request Form. Given the population it serves, expect a higher share of complex cases at intake — though PathWays for Aging skews toward an adult/dual-eligible population less likely to need pediatric ABA.

This plan administers the **Indiana Medicaid (IHCP)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Indiana Medicaid (IHCP) guide](https://carelu.com/payers/indiana-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — via Optum: ABA Treatment Request Form through Provider Express, phone (877) 610-9785, or fax (844) 897-6514 [1][2]
- **Prior auth for treatment**: Required — Hoosier Care Connect decisions follow IC 27-1-37.5-23 (eff. 7/1/2025): urgent within 24 hours, all other PA requests (including continuations) within 48 hours, weekends and state/federal holidays excluded; a missed deadline means the service is deemed authorized [25][26][28][2]
- **Autism diagnosis required?**: Yes — ASD with a comprehensive diagnostic evaluation (CDE) + physician referral [4]

## At a glance

- **Plan type:** IHCP MCE — Hoosier Care Connect + PathWays for Aging ONLY (not HIP/Hoosier Healthwise)
- **Clinical rules:** Indiana Medicaid policy first, then UHC policy, then InterQual
- **ABA network:** Optum-managed — credentialed separately from UHC medical
- **Prior auth:** Required — ABA Treatment Request Form via Provider Express
- **Timelines:** Hoosier Care Connect: urgent 24 hrs, all other PA 48 hrs, weekends/holidays excluded (IC 27-1-37.5-23); missed deadline = deemed approved
- **Note:** Most routine outpatient BH needs no PA at UHC — ABA is the exception
- **Diagnosis recency:** State rule: CDE >1 year old needs an updated statement of need

## The Optum carve-out, in practice

Optum was selected by UHC Community Plan to build and manage the Indiana ABA network, which means ABA providers must be in the Optum network — credentialed separately from UHC's medical side — and enrolled with Indiana Medicaid before joining. Behavioral-health PA runs by phone at (877) 610-9785 (or the number on the member's card), through Provider Express ("Auth Request"), or by faxing the IHCP universal PA form to (844) 897-6514; ABA specifically uses Optum's ABA Treatment Request Form from the Provider Express Indiana Medicaid ABA Program page, which also hosts the provider orientation and quick-reference guide. [1][2][24][7][25][26][27][28][29]

Decision timelines are set by Indiana law, not by UHC's older published figures. Since July 1, 2025, IC 27-1-37.5-23 binds Indiana's Medicaid risk-based managed care (IC 27-1-37.5-5(a)(3)), which includes Hoosier Care Connect: an urgent PA request gets an answer “not later than twenty-four (24) hours after receiving the request,” every other request “not later than forty-eight (48) hours,” and “The time frames set forth in this section do not include weekends and state and federal legal holidays.” If UHC misses the deadline, “the health care service subject to prior authorization shall be automatically deemed authorized” (IC 27-1-37.5-28). UHC's 2024 Hoosier Care Connect manual still prints slower pre-statute timelines (non-urgent pre-service “Within 5 calendar days,” urgent “Within 48 hours”), and the statute overrides them. The statute does not apply to “health care services provided under” the PathWays for Aging waiver (IC 27-1-37.5-1(c)); for those, the federal Medicaid managed-care ceiling of 7 calendar days (72 hours expedited) applies (42 CFR 438.210(d)). Denials appeal to UHC's National Appeals Team (fax (855) 312-1470, phone (866) 556-8166). The current Hoosier Care Connect and PathWays for Aging PA requirement lists took effect October 1, 2026 (page last updated October 5, 2026); their behavioral-health row is unchanged from the September list — “Prior authorization required. For specific codes requiring prior authorization, please call the” number on the member's ID card — so ABA codes are not itemised there. UHC reissues these lists most months; re-check the page before relying on a code-level answer. [1][2][24][7][25][26][27][28][29]

## Is UnitedHealthcare Community Plan's ABA network open to new providers?

Not to new agencies, while Indiana's ABA enrollment moratorium lasts. IHCP Bulletin BT202692 (6/4/2026): a CMS-approved moratorium, effective June 6, 2026 for an initial six months and extendable in six-month increments, "will prevent enrollment for brand-new ABA group enrollments as well as changes of ownership for existing ABA therapy agencies"; individual rendering-provider (RBT/BCaBA/BCBA) enrollment is not affected. That reaches UnitedHealthcare Community Plan's network because federal rule requires the state to "screen and enroll" every network provider of its managed-care plans, and a plan must drop a network provider the state cannot enroll. Accredited agencies can ask IHCP for an access exception at OMPPProviderRelations@fssa.in.gov. Whether UnitedHealthcare Community Plan is adding already-enrolled ABA agencies to its panel is a contracting question — the plan publishes no open/closed statement for ABA. [8][9]

## Can an out-of-state BCBA treat an Indiana member, including by telehealth?

Indiana licenses the practice: an individual may not “practice applied behavior analysis” unless the individual “holds a license issued under this chapter” (IC 25-8.5-3-6(a)); the PLA takes reciprocity applications ($75 for an LBA). Indiana’s telehealth law (IC 25-1-9.5) defines a telehealth “practitioner” as someone holding “an unlimited license to practice” in Indiana and lists “a behavior analyst licensed under IC 25-8.5,” so plan on an Indiana license before treating a child located in Indiana remotely. [12][13][14][15][16]

Indiana Medicaid enrolls some out-of-state providers (405 IAC 5-5), but the IHCP Provider Enrollment Type and Specialty Matrix “indicates which provider types and specialties are ineligible for out-of-state enrollment,” and “In general, all out-of-state services rendered to IHCP members require prior authorization (PA)” on top of the ABA PA. That extra out-of-state PA is waived for “Telehealth services if providers have the subtype ‘Telemedicine’ attached to their enrollment,” and for providers granted “in-state” status for service locations in designated border-area counties (Cook County, Illinois, is one). Check the Matrix for the ABA specialties (615, 624, 625) before applying. [12][13][14][15][16]

Federal rules make the state Medicaid enrollment rule binding on the plan: the state “must screen and enroll, and periodically revalidate, all network providers” of Medicaid managed care plans (42 CFR 438.602(b)(1)). So a BCBA in UnitedHealthcare Community Plan’s network has to be enrolled with the IHCP as well. [12][13][14][15][16]

## UnitedHealthcare Community Plan of Indiana ABA claims: filing deadline and payment clock

Filing deadline: UnitedHealthcare’s 2026 IHCP Works sessions set 90 calendar days from the date of service for participating and non-contracted providers, and 90 calendar days from the primary explanation of benefits for a secondary claim; a claim reconsideration (including a corrected claim) is due within 90 calendar days of the original EOB, electronic payer ID 87726. [20][21][22]

Payment clock: the UnitedHealthcare sessions print no payment timeframe. The federal floor every Indiana MCE contract must carry is 42 CFR 447.46: pay 90% of clean practitioner claims within 30 days of receipt and 99% within 90 days, unless the plan and provider agree an alternative schedule in the contract. [20][21][22]

## Reauthorization: what a continuation PA must contain (graphs required)

Follows the Indiana Medicaid rule — IHCP states that its ABA “documentation requirements outlined in IHCP policy are applicable to both FFS and managed care” (BT202562). Reauthorization: each ABA PA runs up to six months, and continuing past it takes a new PA request. It is approved when the member still meets ABA criteria and the treatment plan is resubmitted with measurable progress to date on each goal, a revised timeline for each goal based on the initial and interim assessments, clinically significant progress in social, communication and language skills, adaptive functioning and behavior, and updates to hours, schedule, parent training and school-transition plans. Continuing members need no new comprehensive diagnostic evaluation but do need an updated behavior assessment and treatment plan (BT202562), and the behavior assessment’s “complete scoring report, including outcome measure scores and graphs, must be submitted with prior authorization requests.” Graphs are therefore required — of the standardized assessment results — and discharge follows when measurable functional improvement is not documented or progress stalls across successive authorization periods. [4][5][3]

Code set (IHCP rule): ABA bills under CPT 97151–97158, 0362T and 0373T with IHCP’s credential, group-size and UA modifiers (BT202627); BT202562 adds that each MCE sets its own billing and reimbursement requirements, so confirm any plan-specific edits. [4][5][3]

## Intake gates

The questions that decide whether a family can start with UnitedHealthcare Community Plan of Indiana, and what they have to bring.

- **Age limit**: Follows the Indiana Medicaid rule: ABA is covered for members 20 years of age and younger. Effective April 1, 2026 coverage runs exclusively through EPSDT, and for dates of service on or after October 1, 2026 IHCP no longer authorizes or reimburses ABA for members 21 and older — a state policy that binds every MCE. [4][3][5]
- **Diagnosis recency**: Follows the Indiana Medicaid rule: a CDE more than one year old requires an updated statement of need, which must include a referral from an appropriate referring practitioner and an up-to-date behavior assessment completed by the ABA provider. Members continuing current services need no new CDE but do need an updated behavior assessment and treatment plan. A behavior assessment completed within the previous six months should be obtained from the original provider rather than repeated. IHCP states these documentation requirements apply to managed care as well as fee-for-service. BT2026160 (9/29/2026) since narrowed when that paperwork is due: “statement of need” and “referral” now mean the same thing, and one is required only at onset of ABA if the CDE is more than a year old, at reauthorization when an active member’s CDE crosses one year, or with a new PA after a six-month gap in ABA services — not with every reauthorization or annually — while reassessment and an updated treatment plan are still due at least every six months. [5][4][10]
- **Who may diagnose**: Indiana Medicaid policy sits first in UHC's own stated criteria hierarchy (state policy, then UHC policy, then InterQual), so the state list governs: the CDE must be performed by a doctoral-level licensed clinical psychologist endorsed as an HSPP, a licensed physician, a licensed APRN, or a licensed physician assistant with specialized training in the current DSM autism criteria. Do not substitute Optum's national commercial criteria here — the carve-out supplies the rails, not the clinical standard. [5][1]
- **Diagnostic tools required**: Follows the Indiana Medicaid rule: the behavior assessment must include the Vineland Comprehensive Parent Interview Form with the Maladaptive Behavior domain, the BASC Parenting Relationship Questionnaire and an age-appropriate objective direct skills assessment, with the complete scoring report, outcome measure scores and graphs submitted with the PA; only BASC-4 satisfies the requirement after October 1, 2026. Requests are submitted on Optum's ABA Treatment Request Form from the Provider Express Indiana Medicaid ABA Program page, or by faxing the IHCP universal PA form to (844) 897-6514. [4][6][1][2]
- **Referral required?**: Follows the Indiana Medicaid rule: a physician must make a treatment referral recommending ABA therapy, and the CDE’s own required components include a physician’s referral for autism-specific services. Under BT2026160 (9/29/2026) the referral/statement of need must come from an HSPP-endorsed doctoral psychologist, a licensed physician, a licensed APRN or a licensed physician assistant — a BCaBA, BCBA, PT, SLP or OT cannot complete it. Prior authorization is required on top of the referral for every ABA service, through this plan rather than through Acentra Health. [4][5][10]
- **Telehealth**: Follows the Indiana Medicaid rule, with no ABA telehealth policy of the plan’s own. Effective April 1, 2026, IHCP no longer allows 97151, 97152, 97153, 97154 or 0373T to be billed with telehealth modifier 95, so the assessment, reassessments and all direct and group treatment are in person. Only 97155 and 97156 remain telehealth-eligible; IHCP’s provider reference module adds that RBTs and BCaBAs may not deliver any ABA service via telehealth, that remote 97155 is payable only when an HSPP, BCBA or BCBA-D supervises an RBT who is delivering 97153 in person, and that audio-only ABA is never reimbursable (modifier 95 plus U3). IHCP Bulletin BT202662 (4/28/2026) adds that supervision “may be rendered via synchronous telehealth and billed using modifier 95” but “is intended to supplement, not replace, the majority of in-person services.” The module is written for fee-for-service and IHCP says MCEs set their own billing requirements, so confirm with the plan before billing remote 97155 or 97156. Optum, which manages the behavioral benefit, adds a claim rule across all lines of business including Medicaid/Community Plan: every behavioral health telehealth claim must carry POS 02 (member not at home) or POS 10 (member at home), and claims billed with only a telehealth modifier are not reimbursed (Telehealth Billing Quick Reference Guide, September 2025). [33][3][4][5][11]
- **Prior-auth decision time**: Indiana law sets the binding clock, and it is far faster than the federal one. Since July 1, 2025, IC 27-1-37.5-23 requires a utilization review entity to answer an urgent PA request “not later than twenty-four (24) hours after receiving the request” and every other request “not later than forty-eight (48) hours,” with “weekends and state and federal legal holidays” excluded from both clocks; the chapter's “health plan” expressly includes “the Medicaid risk based managed care program” (IC 27-1-37.5-5), and IC 27-1-37.5-28 makes a missed deadline an automatic approval: the service “shall be automatically deemed authorized.” The federal managed-care floor, 42 CFR 438.210(d), is only a ceiling for states (7 calendar days standard for rating periods starting on or after 1/1/2026, extendable 14 days; 72 hours expedited), so the stricter Indiana clock wins. UHC's own published numbers predate the statute and are slower: its 2024 IHCP Works deck lists non-urgent pre-service “Within 7 calendar days of receipt of medical record information required but no longer than 14 calendar days from receipt,” urgent within 48 hours and concurrent within 1 business day, and its Hoosier Care Connect Care Provider Manual (2024 edition) lists non-urgent within 5 calendar days, urgent 48 hours, concurrent 24 hours or next business day. Hold the plan (and Optum, which reviews its ABA) to the statute. No ABA reauthorization lead time is published for the Indiana Medicaid ABA program. [25][26][34][1][35][29]
- **Other insurance (who pays first)**: UHC Community Plan pays last: its Hoosier Care Connect manual says it “is, by law, the payer of last resort for eligible members. Therefore, you must bill and obtain an explanation of benefits (EOB) from any other insurance or health care coverage resource before billing,” then attach a complete copy of that EOB to the claim. Get this plan's ABA PA even when it is secondary: the IHCP Prior Authorization module says that when the member has primary coverage, the provider “must follow the primary insurer's requirements for obtaining PA and must also obtain PA from the appropriate IHCP PA contractor (based on the program assignment of the member) to receive payment from the IHCP for the balance of charges not paid by the primary insurance.” The UHC manual publishes nothing different on PA-when-secondary, and the IHCP TPL module adds that IHCP will not pay for services the primary denied as out-of-network, so be in the commercial plan's network. TRICARE is not a problem here: 32 CFR 199.8 excludes Medicaid from the “double coverage plans” TRICARE pays after, so for a child with both, TRICARE pays before Medicaid. [35][36][37][38]

## Delivery and billing rules

Coverage decides whether UnitedHealthcare Community Plan of Indiana pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Follows the Indiana Medicaid rule: ABA performed by a BCaBA or credentialed RBT must be under the direct supervision of a BCBA, BCBA-D or HSPP, and since April 1, 2026 at least 1 hour of BCBA (or IHCP-approved qualifying clinician) supervision is required per 8 hours of technician-delivered therapy. Behavior assessments may only be performed by a psychologist, BCBA-D or master's-level BCBA. IHCP states that its ABA documentation requirements apply to both fee-for-service and managed care, and this plan publishes no supervision standard of its own. BT202662 (4/28/2026) defines how the floor is measured: monthly, per member (“not aggregated across technicians or across Medicaid members”), proportionally when a member gets fewer than eight technician hours in the month, and counting both billable 97155 and documented nonbillable case supervision (fidelity checks, session-note review) — but not administrative supervision such as scheduling or staff meetings. Shortfalls are subject to claim audit, postpayment review and recoupment. [4][3][5][11]
- **Daily limits / MUEs**: Follows the Indiana Medicaid limits: up to 40 hours per week may be requested with anything beyond that needing an additional PA; IHCP policy limits each ABA PA request to six months; and since April 1, 2026 comprehensive ABA (16+ hours/week, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation per member, with 97155 and 97156 excluded and targeted ABA (≤15 hours/week) exempt. At the state level IHCP applies the Medicaid NCCI MUEs to fee-for-service professional claims per member, per rendering provider, per date of service (CMS Q4 2026 table: 97153 at 32 units, 97155 at 24, 97151 at 32, 97156 at 16); the IHCP NCCI module leaves managed care claims to each MCE, so confirm the plan’s own daily edits. Open question for managed care: IC 27-1-37.5-26(b), in force since July 1, 2025 and reaching Medicaid risk-based managed care through IC 27-1-37.5-5(a)(3), says an authorization "shall be valid for at least one (1) year after the date the health care provider receives the authorization," and CareSource's July 2025 IHCP Works deck lists "Approved Authorization — Valid for 365 calendar days." But IHCP Bulletin BT2026136 (8/18/2026), addressed to the MCOs and the FFS PA-UM contractor alike, still describes ABA as running on a "standard six-month authorization period." No IHCP bulletin or MCE notice we could find reconciles the two, so ask the MCE which span it is issuing before you plan a reauthorization calendar. [18][19][4][3][30][31][26][32]
- **Session-note signature**: Follows the Indiana Medicaid rule; the plan publishes no session-note rule of its own. IHCP’s ABA documentation requirements require "session notes, which must be signed by the rendering practitioner," each including the date, time, location and duration of services and the session-specific targeted skills and the member’s response to the treatment plan goals, producible within 72 hours of a request; the behavior assessment and treatment plan must each be signed by the lead analyst and the parent or guardian. IHCP states that "documentation requirements outlined in IHCP policy are applicable to both FFS and managed care." No signing deadline is published. [4][5]
- **Place of service**: Follows the Indiana Medicaid rule: the treatment plan must be built around the member's school attendance (including homeschooling) and other daily activities, while services focusing solely on recreational or educational outcomes are not covered, and neither are services duplicative of an IEP that address the same goals using the same techniques as the treatment plan. [4]
- **Bill as provider**: Follows the Indiana Medicaid rule: ABA rendered by a BCaBA or RBT must be billed under the NPI of an IHCP-enrolled ABA therapist or school corporation, on a professional claim. Since July 1, 2025 the rendering practitioner must be enrolled under ABA specialty 615, 624 or 625, and since April 1, 2025 the rendering NPI must align with the credential-level modifier (U1 RBT / U2 BCaBA / U3 BCBA-HSPP). Plan-level claim formatting may still differ — MCEs publish their own billing requirements. [4][3]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not published by Indiana Medicaid or by this plan. IHCP is explicit that within managed care “individual managed care entities (MCEs) establish and publish their own billing and reimbursement requirements,” so unlike the clinical criteria, code-pair rules are not inherited from the state by default. The IHCP rule this plan may or may not mirror: BT202662 (4/28/2026) says “CPT code 97155 may be billed concurrently only with CPT codes 97153 and 97154,” and only when the analyst is actively directing the technician through a modified protocol. [5][11]
  - Ask the plan: The MCE directly — ask whether 97155 pays alongside 97153 for the same clock time, and request the plan's billing and reimbursement requirements in writing.

## What intake should collect for UnitedHealthcare Community Plan of Indiana

- **Program confirmation:** Confirm the member is on Hoosier Care Connect or PathWays for Aging — UHC does not administer HIP or Hoosier Healthwise in Indiana.
- **Optum network status:** ABA requires Optum credentialing, separate from UHC medical — confirm before quoting start dates.
- **IHCP clinical package:** CDE, physician referral, behavior assessment — state criteria govern the request.
- **Guardianship / placement details:** Foster-care members bring consent and guardianship questions standard intake misses.
- **Age + lifetime-allocation status:** The 2026 state rules apply to Hoosier Care Connect members too.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How UnitedHealthcare Community Plan of Indiana ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Behavioral health administrator:** Optum Behavioral Health
- **ABA rides on:** behavioral health benefit — Optum manages the ABA network/credentialing/PA per the IHCP Works deck, but claims may still route on the shared medical payer ID — the medical/BH split for the EDI hop itself is not confirmed.
- **Two-hop verification required:** Yes

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | No — modifier 95 (synchronous telemedicine) may not be billed with this code for DOS on/after 4/1/2026 (BT202627). | U2, U3, UA (if comprehensive) |
| 97152 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | No — modifier 95 (synchronous telemedicine) may not be billed with this code for DOS on/after 4/1/2026 (BT202627). | U1, UA (if comprehensive) |
| 97153 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | No — modifier 95 (synchronous telemedicine) may not be billed with this code for DOS on/after 4/1/2026 (BT202627). | U1, U2, U3, UA (if comprehensive) |
| 97154 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | No — modifier 95 (synchronous telemedicine) may not be billed with this code for DOS on/after 4/1/2026 (BT202627). | U1, U4/U6/U8 (group size, required), UA (if comprehensive) |
| 97155 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | Not restricted by BT202627's 4/1/2026 telehealth change; no code-specific POS/modifier detail published for telehealth delivery of this code otherwise. | U2, U3 |
| 97156 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | Not restricted by BT202627's 4/1/2026 telehealth change; no code-specific POS/modifier detail published for telehealth delivery of this code otherwise. | U2, U3 |
| 97157 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | Not restricted by BT202627's 4/1/2026 telehealth change; no code-specific POS/modifier detail published for telehealth delivery of this code otherwise. | U2, U3, U4/U6/U8 (group size, required), UA (if comprehensive) |
| 97158 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | Not restricted by BT202627's 4/1/2026 telehealth change; no code-specific POS/modifier detail published for telehealth delivery of this code otherwise. | U2, U3, U4/U6/U8 (group size, required), UA (if comprehensive) |
| 0362T | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | Not restricted by BT202627's 4/1/2026 telehealth change; no code-specific POS/modifier detail published for telehealth delivery of this code otherwise. | U1, UA (if comprehensive) |
| 0373T | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | No — modifier 95 (synchronous telemedicine) may not be billed with this code for DOS on/after 4/1/2026 (BT202627). | U1, UA (if comprehensive) |

Code notes:

- **97151:** Behavior identification assessment by professional, each 15 minutes. Verify via: Provider Express ABA Treatment Request Form / Optum Indiana Medicaid ABA Program page — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **97152:** Behavior identification assessment by technician, each 15 minutes. Verify via: Provider Express ABA Treatment Request Form / Optum Indiana Medicaid ABA Program page — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **97153:** Adaptive behavior treatment by technician; U2/U3 (BCaBA/BCBA) tiers newly allowable for this code effective 4/1/2026 (previously RBT/U1-only). Verify via: Provider Express ABA Treatment Request Form / Optum Indiana Medicaid ABA Program page — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **97154:** Group ABA treatment by technician — group-size modifier required; no individual/non-group rate exists for this code. Verify via: Provider Express ABA Treatment Request Form / Optum Indiana Medicaid ABA Program page — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **97155:** Adaptive behavior treatment by professional using an established plan. May be billed concurrently with technician-delivered 97153 when the QHP directs a present technician. Excluded from the 4,000-hour comprehensive-ABA lifetime allocation. Verify via: Provider Express ABA Treatment Request Form / Optum Indiana Medicaid ABA Program page — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **97156:** Adaptive behavior treatment by professional with family. Excluded from the 4,000-hour comprehensive-ABA lifetime allocation. Verify via: Provider Express ABA Treatment Request Form / Optum Indiana Medicaid ABA Program page — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **97157, 97158:** Group-only code — no individual/non-group rate exists. Verify via: Provider Express ABA Treatment Request Form / Optum Indiana Medicaid ABA Program page — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **0362T:** Behavior identification supporting assessment for destructive behavior, technician face-to-face time. Verify via: Provider Express ABA Treatment Request Form / Optum Indiana Medicaid ABA Program page — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **0373T:** Adaptive behavior treatment with protocol modification for destructive behavior, technician face-to-face time. Verify via: Provider Express ABA Treatment Request Form / Optum Indiana Medicaid ABA Program page — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.

### Medicaid rates

Source: IHCP Bulletin BT202627 (Feb 26, 2026), Tables 1-3 — state fee-schedule maximum. MCE-contracted rates are negotiated separately per plan and not independently published; this is the benchmark cited in every Indiana Medicaid ABA guide. Effective 2026-04-01.

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | $20.56 (U2, BCaBA) / $25.97 (U3, BCBA/BCBA-D/HSPP/physician) | 15min | U2: $20.56 (DOS ≥4/1/2026) → $19.74 (DOS ≥4/1/2027); U3: $25.97 (DOS ≥4/1/2026) → $24.93 (DOS ≥4/1/2027) |
| 97152 | $16.04 (U1, RBT) | 15min | U1: $16.04 (DOS ≥4/1/2026) → $15.39 (DOS ≥4/1/2027) |
| 97153 | $16.04 (U1/U2/U3 — uniform across all three practitioner tiers since 4/1/2026) | 15min | U1: $16.04 (DOS ≥4/1/2026) → $15.39 (DOS ≥4/1/2027); pre-4/1/2026 was $17.06 (U1 only — U2/U3 not allowable for 97153 before that date); U2: $16.04 (DOS ≥4/1/2026) → $15.39 (DOS ≥4/1/2027) — N/A before 4/1/2026; U3: $16.04 (DOS ≥4/1/2026) → $15.39 (DOS ≥4/1/2027) — N/A before 4/1/2026 |
| 97154 | Group-only (no individual/non-group rate published) — $9.21 (U1+U4, group of 2), DOS ≥4/1/2026 | 15min | U1+U4 (group of 2): $9.21 (DOS ≥4/1/2026) → $8.84 (DOS ≥4/1/2027); pre-4/1/2026 flat rate (any group size) was $4.87; U1+U6 (group of 3): $6.14 (DOS ≥4/1/2026) → $5.90 (DOS ≥4/1/2027); U1+U8 (group of 4-8): $4.61 (DOS ≥4/1/2026) → $4.43 (DOS ≥4/1/2027) |
| 97155 | $20.54 (U2, BCaBA) / $25.97 (U3, BCBA) | 15min | U2: $20.54 (DOS ≥4/1/2026) → $19.72 (DOS ≥4/1/2027); U3: $25.97 (DOS ≥4/1/2026) → $24.93 (DOS ≥4/1/2027) |
| 97156 | $20.56 (U2, BCaBA) / $26.54 (U3, BCBA) | 15min | U2: $20.56 (DOS ≥4/1/2026) → $19.74 (DOS ≥4/1/2027); U3: $26.54 (DOS ≥4/1/2026) → $25.47 (DOS ≥4/1/2027) |
| 97157 | Group-only — $11.82 (U2+U4, group of 2), DOS ≥4/1/2026 | 15min | U2+U4 (group of 2): $11.82 → $11.35 (4/1/2027); pre-4/1/2026 flat rate (any size) was $6.25 (U2); U2+U6 (group of 3): $7.88 → $7.57 (4/1/2027); U2+U8 (group of 4-8): $5.91 → $5.68 (4/1/2027); U3+U4 (group of 2): $14.93 → $14.33 (4/1/2027); pre-4/1/2026 flat rate (any size) was $7.89 (U3); U3+U6 (group of 3): $9.95 → $9.56 (4/1/2027); U3+U8 (group of 4-8): $7.46 → $7.16 (4/1/2027) |
| 97158 | Group-only — $11.82 (U2+U4, group of 2), DOS ≥4/1/2026 (identical rate structure to 97157) | 15min | U2+U4 (group of 2): $11.82 → $11.35 (4/1/2027); pre-4/1/2026 flat rate (any size) was $6.25 (U2); U2+U6 (group of 3): $7.88 → $7.57 (4/1/2027); U2+U8 (group of 4-8): $5.91 → $5.68 (4/1/2027); U3+U4 (group of 2): $14.93 → $14.33 (4/1/2027); pre-4/1/2026 flat rate (any size) was $7.89 (U3); U3+U6 (group of 3): $9.95 → $9.56 (4/1/2027); U3+U8 (group of 4-8): $7.46 → $7.16 (4/1/2027) |
| 0362T | $26.83 (U1) | 15min | U1: $26.83 (DOS ≥4/1/2026) → $25.75 (DOS ≥4/1/2027) |
| 0373T | $26.83 (U1) | 15min | U1: $26.83 (DOS ≥4/1/2026) → $25.75 (DOS ≥4/1/2027) |

### Contacts

- **Benefits by phone:** Yes
- **Provider services phone:** 877-610-9785 (UnitedHealthcare Community Plan of Indiana Provider Services)
- **Phone menu path:** For ABA-specific issues, ask to be routed to Optum Behavioral Health (800-888-2998) or the Indiana Autism/ABA Network Management Provider Advocate (715-833-6538) rather than general medical Provider Services.
- **Hours:** 8 a.m.–8 p.m. Eastern Time, Monday–Friday
- **Portal:** [Provider Express (Optum Behavioral Health)](https://public.providerexpress.com)
- **Fax:** 844-897-6514 (Optum Behavioral Health / prior authorization fax)

Questions to ask on a verification call:

- What is the correct pVerify/Availity payer ID for Indiana Community Plan 270/271 eligibility checks? (No Indiana-specific ID confirmed yet.)
- Do ABA claims route on Optum's own BH payer ID, or the shared UHC medical ID (87726)?
- What are the per-code unit caps, POS, and modifier requirements for this member's ABA authorization? (Only the statewide IHCP pattern is on file, not a UHC/Optum-specific table.)

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://www.in.gov/medicaid/providers/files/IHCP-Works-2024-UHC-Prior-Authorization.pdf (accessed 2026-07-23)
- https://www.in.gov/medicaid/providers/files/270-271-ihcp-companion-guide.pdf (accessed 2026-07-23)
- https://provider.indianamedicaid.com/ihcp/Publications/providerCodes/Behavioral_Health_Services_Codes.pdf (accessed 2026-07-23)
- https://www.in.gov/medicaid/providers/files/bulletins/BT202627.pdf (accessed 2026-07-23)
- https://www.in.gov/medicaid/providers/files/modules/behavioral-health-services.pdf (accessed 2026-07-23)
- https://www.uhcprovider.com/en/health-plans-by-state/indiana-health-plans/in-comm-plan-home.html (accessed 2026-07-23)
- https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/comm-plan/Indiana_Provider_Manual.pdf (accessed 2026-10-14)

## Common questions

### Does UnitedHealthcare Community Plan of Indiana cover ABA?

Yes — for Hoosier Care Connect and PathWays for Aging members, administered through an Optum Behavioral Health carve-out under Indiana Medicaid clinical criteria, with PA on all ABA via Optum's ABA Treatment Request Form. UHC does not serve HIP or Hoosier Healthwise members in Indiana — those route to Anthem, CareSource, or MHS.

### How fast does UHC/Optum decide Indiana ABA authorizations?

Indiana law sets the clock for Hoosier Care Connect: IC 27-1-37.5-23 requires an answer within 24 hours for urgent requests and 48 hours for all others, not counting weekends and state/federal holidays, and a missed deadline means the service is deemed authorized (IC 27-1-37.5-28). UHC's older manual figures are slower; the statute controls.

### Do I need separate credentialing for UHC Indiana ABA?

Yes — the ABA network is Optum-managed and credentialed separately from UHC medical, and providers must also be enrolled with Indiana Medicaid first.

### Is UnitedHealthcare Community Plan accepting new ABA providers?

Not new agencies while Indiana's ABA enrollment moratorium lasts (effective June 6, 2026, renewable six months at a time): MCE network providers must be IHCP-enrolled, and the moratorium blocks new ABA group enrollments and changes of ownership. Existing IHCP-enrolled agencies should ask UnitedHealthcare Community Plan provider contracting about panel openings.

### What happens if a family switches ABA providers while on UnitedHealthcare Community Plan?

UnitedHealthcare Community Plan publishes no rule on transferring an open ABA authorization, so expect the new agency to submit its own PA and confirm with UnitedHealthcare Community Plan UM whether the old one must be closed first. Under IHCP documentation policy, which applies to managed care, a new provider is expected to obtain a behavior assessment completed within the last six months from the original provider instead of re-testing, and the member's 4,000-hour lifetime comprehensive-ABA allocation carries over.

### Can an out-of-state BCBA treat UnitedHealthcare Community Plan members in Indiana, including by telehealth?

Indiana requires an Indiana license (IC 25-8.5-3-6), and its telehealth law counts only Indiana-licensed behavior analysts as practitioners. The IHCP enrolls some out-of-state providers, but out-of-state services generally need extra PA and some specialties are ineligible; check the Enrollment Matrix.

### Does UnitedHealthcare Community Plan of Indiana authorize ABA retroactively?

We have not verified UHC’s current Indiana rule. The IHCP’s retroactive-PA list is written for fee-for-service; for managed care members the IHCP Prior Authorization module sends providers to the MCE’s own manual. Ask UHC before treating without an approved PA.

### Do we bill this plan for ABA written into a child’s IEP?

No. Indiana carves school-based Medicaid services out of managed care: the IHCP School Corporation Services module (Sept. 29, 2026) says school corporations “must not submit claims for these services to the student’s managed care entity (MCE)” and bill fee-for-service (Gainwell) instead, with modifier TM on every code and the education plan serving as prior authorization. ABA your agency delivers outside the school program still goes through the plan.

### What is UnitedHealthcare Community Plan of Indiana’s timely filing limit?

90 calendar days from the date of service; secondary claims 90 days from the primary EOB; reconsiderations and corrected claims 90 days from the original EOB. No payment-day figure is published; the federal MCO floor is 90% of clean claims within 30 days.

### Does UnitedHealthcare Community Plan of Indiana require graphs for an ABA reauthorization?

Yes — IHCP’s ABA documentation rules apply to managed care: the behavior assessment’s complete scoring report, including outcome scores and graphs, goes with every PA request, along with an updated treatment plan showing measurable progress on each goal.

## Primary sources

1. [UHC — IHCP Works 2024 Prior Authorization deck](https://www.in.gov/medicaid/providers/files/IHCP-Works-2024-UHC-Prior-Authorization.pdf)
2. [UHC Community Plan of Indiana — prior authorization page](https://www.uhcprovider.com/en/health-plans-by-state/indiana-health-plans/in-comm-plan-home/in-cp-prior-auth.html)
3. [IHCP Bulletin BT202627 — ABA policy updates](https://www.in.gov/medicaid/providers/files/bulletins/BT202627.pdf)
4. [IHCP — Behavioral Health Services module (PROMOD00039, ABA section)](https://www.in.gov/medicaid/providers/files/modules/behavioral-health-services.pdf)
5. [IHCP Bulletin BT202562 — ABA documentation requirements (5/2025)](https://www.in.gov/medicaid/providers/files/bulletins/BT202562.pdf)
6. [IHCP Bulletin BT2026123 — BASC-3 PRQ to BASC-4 transition (7/2026)](https://www.in.gov/medicaid/providers/files/bulletins/BT2026123.pdf)
7. [FSSA — Indiana Medicaid managed care health plans (program-by-MCE roster)](https://www.in.gov/medicaid/partners/medicaid-partners/managed-care-health-plans/)
8. [IHCP Bulletin BT202692 — ABA agency provider enrollment moratorium (6/4/2026)](https://www.in.gov/medicaid/providers/files/bulletins/BT202692.pdf)
9. [42 CFR 438.602 — State screening and enrollment of MCO network providers (eCFR)](https://www.ecfr.gov/current/title-42/section-438.602)
10. [IHCP Bulletin BT2026160 — ABA statement of need and referral requirements clarified (9/29/2026)](https://www.in.gov/medicaid/providers/files/bulletins/BT2026160.pdf)
11. [IHCP Bulletin BT202662 — Additional ABA guidance: supervision, caregiver coaching, UA modifier (4/28/2026)](https://www.in.gov/medicaid/providers/files/bulletins/BT202662.pdf)
12. [Ind. Code § 25-8.5-3-6 — license required to practice applied behavior analysis](https://codes.findlaw.com/in/title-25-professions-and-occupations/in-code-sect-25-8-5-3-6/)
13. [Indiana PLA — Telehealth (IC 25-1-9.5) definitions](https://www.in.gov/pla/resources/telehealth-home)
14. [Indiana PLA — Behavior Analyst licensing information (fees incl. reciprocity application)](https://www.in.gov/pla/professions/behavior-analyst/behavior-analyst-licensing-information)
15. [IHCP — Out-of-State Providers module (PROMOD00011, published May 29, 2026)](https://www.in.gov/medicaid/providers/files/modules/out-of-state-providers.pdf)
16. [eCFR — 42 CFR 438.602(b)(1): the state must screen and enroll all managed care network providers](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-H/section-438.602)
17. [IHCP — School Corporation Services module (PROMOD00046, published Sept. 29, 2026)](https://www.in.gov/medicaid/providers/files/modules/school-corporation-services.pdf)
18. [IHCP — National Correct Coding Initiative module (PROMOD00010, v7.0, publ. Dec. 23, 2024)](https://www.in.gov/medicaid/providers/files/modules/national-correct-coding-initiative.pdf)
19. [CMS — Medicaid NCCI MUE edits, practitioner services (2026 Q4, active 10/1–12/31/2026)](https://www.cms.gov/files/zip/medicaid-ncci-2026-q4-mue-edits-practitioner-services.zip)
20. [IHCP Works 2026 — UnitedHealthcare: Navigating UHC](https://www.in.gov/medicaid/providers/files/IHCP-Works-2026-UHC-Navigating-UHC.pdf)
21. [IHCP Works 2026 — UnitedHealthcare: Behavioral Health](https://www.in.gov/medicaid/providers/files/IHCP-Works-2026-UHC-Behavioral-Health.pdf)
22. [42 CFR 447.46 — timely claims payment by MCOs (eCFR)](https://www.ecfr.gov/current/title-42/section-447.46)
23. [UnitedHealthcare Community Plan of Indiana — Bulletins and Newsletters (state bulletins archive)](https://www.uhcprovider.com/en/health-plans-by-state/indiana-health-plans/in-comm-plan-home/in-cp-news.html)
24. [UHC Community Plan — Prior Authorization Indiana Hoosier Care Connect, effective Oct 1, 2026](https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/in/priorauth/IN-Hoosier-Connect-Effective-10-1-2026.pdf)
25. [Ind. Code 27-1-37.5-23 — prior authorization response deadlines](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-23/)
26. [Ind. Code 27-1-37.5-5 — “health plan” includes Medicaid risk-based managed care](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-5/)
27. [Ind. Code 27-1-37.5-1 — chapter scope (PathWays for Aging waiver excluded)](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-1/)
28. [Ind. Code 27-1-37.5-28 — missed deadline = deemed authorized](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-28/)
29. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
30. [IHCP Bulletin BT2026136 — minimum caregiver coaching and training for ABA clarified (8/18/2026)](https://www.in.gov/medicaid/providers/files/bulletins/BT2026136.pdf)
31. [Ind. Code 27-1-37.5-26 — authorization valid for at least one year](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-26/)
32. [CareSource — IHCP Works 2025 Prior Authorization 101 deck](https://www.in.gov/medicaid/providers/files/IHCP-Works-2025-CareSource-Prior-Authorization-101.pdf)
33. [Optum — Telehealth Billing Quick Reference Guide (BH01511, updated September 2025)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/home/Telehealth_Billing_Guide_Updates.pdf)
34. [Indiana SEA 480 (P.L.144-2025) — enrolled act adding IC 27-1-37.5-23 and -28, eff. July 1, 2025](https://iga.in.gov/pdf-documents/124/2025/senate/bills/SB0480/SB0480.06.ENRH.pdf)
35. [UHC Community Plan of Indiana — Hoosier Care Connect Care Provider Manual](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/comm-plan/Indiana_Provider_Manual.pdf)
36. [IHCP — Prior Authorization module (PROMOD00012, v7.2, publ. Nov. 20, 2025)](https://www.in.gov/medicaid/providers/files/modules/prior-authorization.pdf)
37. [IHCP — Third-Party Liability module (PROMOD00017, v7.2, publ. Oct. 9, 2025)](https://www.in.gov/medicaid/providers/files/modules/third-party-liability.pdf)
38. [32 CFR 199.8 — TRICARE double coverage (eCFR)](https://www.ecfr.gov/current/title-32/section-199.8)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.